CBO: GOP bill would slash Medicaid 35 percent over 20 years

A long-term analysis of Senate Republicans’ healthcare legislation found that the bill would slash spending on Medicaid by about 35 percent over the next 20 years, according to the Congressional Budget Office.

The CBO estimated that the bill, called the Better Care Reconciliation Act, will reduce Medicaid spending to 1.6 percent of gross domestic product in 2036, from 2 percent of GDP this year. The nonpartisan agency attributed the cuts to the bill’s cap on per-person spending and the phase-out of funding for Obamacare’s expansion of the program.

“A large gap would grow between Medicaid spending under current law and under this bill,” CBO said in the new analysis. “States would continue to need to arrive at more efficient methods for delivering services and to decide whether to commit more of their own resources, cut payments to healthcare providers and health plans, eliminate optional services, restrict eligibility for enrollment or adopt some combination of those approaches.”

The analysis follows a 10-year look by the agency released earlier this week. The new CBO estimate doesn’t include a projection of how many people would be covered under the Republican bill.

The CBO estimate shows that states would be forced to make trade-offs in how to allocate their far more limited funds. Trump and other administration officials, meanwhile, have said the bill doesn’t cut spending. Trump on Wednesday tweeted a chart showing Medicaid spending under the bill going up by $69 billion in 2026, compared to 2017.

“Democrats purposely misstated Medicaid under new Senate bill—actually goes up,” he wrote. Trump’s tweet followed a similar post from Health and Human Services Secretary Tom Price on Tuesday.

However, under current law, spending would be much higher to cover more of states’ costs for the shared program. With the GOP bill, CBO estimates that spending in 2026 would be $160 billion lower, compared with projections under current law.

“Anyone who tells you Trumpcare isn’t cutting Medicaid is full of it,” Senator Ron Wyden, an Oregon Democrat, tweeted Thursday. The CBO analysis was done at Wyden’s request.

“These cuts will leave states with unfathomable ‘choices,’ like whether sick children get essential treatment or pregnant women get prenatal care or older Americans can receive adequate nursing home care,” Wyden said in a statement.

Meanwhile, Trump on Friday said that if Republican senators can’t strike a deal on their health bill, they should immediately repeal Obamacare and then replace it later, a reversal of the president’s earlier position.

Trump’s suggestion on Twitter came as Senate Majority Leader Mitch McConnell of Kentucky was trying to reach a compromise with Republican senators who are withholding support of his draft bill to repeal and replace Obamacare at the same time.

Trump’s tweet was posted after Senator Ben Sasse, a Nebraska Republican and frequent Trump critic, floated the idea on the "Fox and Friends" TV program Friday morning. Sasse, in a separate statement, said if there isn’t a health deal by July 10, when the Senate returns to session, Trump should call on Congress to “immediately repeal as much of Obamacare as is possible under congressional budget reconciliation rules.”

With his tweet, Trump also appears to be aligning himself with at least one of the conservative holdouts, Senator Rand Paul of Kentucky.

The new suggestion by Trump, Paul and Sasse to do a repeal-only bill first could complicate GOP negotiations further. Republican leaders had originally planned to bring up a lightning-strike repeal bill in January to get it to the president’s desk shortly after he took office, with replace to come later. But moderates and conservatives, including Paul, balked at the idea, for different reasons.

Sasse said in that scenario, Trump should also call on Congress to cancel its August recess and work “through regular order, six days per week” to write a health package that can be voted on by Labor Day in September.

For reprint and licensing requests for this article, click here.